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Case Reports
. 2025 Mar 14;17(3):e80580.
doi: 10.7759/cureus.80580. eCollection 2025 Mar.

High-Flow Congenital Arteriovenous Malformation of the Right Deltoid Muscle in a Pediatric Patient: A Case Report

Mohammad Zaid  1 , Suhaila Ahmed  2 , Avdullah Qafani  2 , Ayman Al-Sibaie  3 , Alaa E Nwilati  2 , Michael G Shahoud  2 , Mamoun Shafaamri  2 , Masoud Shafiei  2 , Asmaa Haj Husin  4 , Deena M Al Qedrah  2 , Mohammad S Faghih  2
Affiliations
Case Reports

High-Flow Congenital Arteriovenous Malformation of the Right Deltoid Muscle in a Pediatric Patient: A Case Report

Mohammad Zaid et al. Cureus. .

Abstract

Congenital arteriovenous malformations (AVMs) are rare vascular anomalies involving abnormal connections between arteries and veins, bypassing the capillary bed. High-flow AVMs may lead to complications such as pain, ulceration, and functional impairment. We report a case of a six-year-old girl with a high-flow AVM in the right deltoid muscle, initially diagnosed via Doppler ultrasound and confirmed by MRI. The patient presented with a progressively enlarging, painless swelling of the right shoulder. Management included super-selective embolization, followed by surgical resection due to symptom recurrence and persistent vascular shunting. Postoperatively, the patient experienced improved shoulder mobility and pain reduction. The treatment plan involved a staged approach, with initial embolization to reduce blood flow, followed by surgical excision to prevent recurrence. The surgical resection was performed soon after the second embolization. Postoperative care included pain management and physiotherapy for optimal recovery. This case emphasizes the importance of early diagnosis, multimodal intervention, and long-term follow-up in pediatric AVMs. Future studies should focus on recurrence predictors, optimal timing for surgical resection post-embolization, and the role of genetic factors in AVM development.

Keywords: arteriovenous malformations; embolization; pediatric; surgical resection; vascular anomalies.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Ultrasound of right deltoid muscle
High-flow arteriovenous malformation (AVM) within the right deltoid muscle, with no evidence of hematoma or fluid collection. Doppler ultrasound showed high diastolic venous flow and arterial flow consistent with an AVM.
Figure 2
Figure 2. Contrast-enhanced MRI of the right humerus
The red arrow points to a large fusiform area with mixed signals occupying the entire right deltoid muscle, with regions of high signal indicating fatty deposition. The lesion measured 8.5 x 4.1 x 4.7 cm, with no extension into surrounding tissues.
Figure 3
Figure 3. Angiography
The red arrow points to the described arteriovenous malformation with four feeder vessels targeted for embolization.
Figure 4
Figure 4. First embolization
Super-selective embolization was performed using Onyx and squid chemical embolization.
Figure 5
Figure 5. Angiography
Previously injected areas with some remaining branches.
Figure 6
Figure 6. Second embolization
Second embolization targeted the feeding arteries using Histoacryl and Lipiodol as embolizing agents.
Figure 7
Figure 7. Surgical field
The image shows intraoperative findings of fragile tissues and dilated vessels constituting the high-flow arteriovenous malformation in the right deltoid muscle.
Figure 8
Figure 8. Excised specimen
The image shows the excised portion of the deltoid muscle and the high-flow arteriovenous malformation.
See this image and copyright information in PMC

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